Clinical Decision Support

We want to make sure that you and your staff understand the new PAMA regulatory requirements and can identify the tools that will be required for successful reporting. To support early adoption, we will be rolling out a Medicare Advanced Imaging Referral Form where referring providers or delegates can document which qCDSM was consulted and what the result was. A free web-based tool is available to support AUC consultation:

CareSelect Imaging – Open Access

 

How does an ordering provider consult ACU?

Ordering providers must utilize a CMS approved Clinical Decision Support tool to perform the AUC Consultation.

 

What are the approved CDSMs?

As of June 2018, the approved CDMS are:

  • AIM Specialty Health ProviderPortal®*
  • Applied Pathways CURION™ Platform
  • Cranberry Peak ezCDS
  • eviCore healthcare’s Clinical Decision Support Mechanism
  • MedCurrent OrderWise™
  • Medicalis Clinical Decision Support Mechanism
  • National Decision Support Company CareSelect™*
    National Imaging Associates RadMD
  • Sage Health Management Solutions Inc. RadWise®
  • Stanson Health’s Stanson CDS
  • Test Appropriate CDSM*

*Free Tool Available


Other CDSMs with preliminary qualifications are:

  • Applied Cerner CDS mechanism
  • Evinance Decision Support
  • Flying Aces Speed of Care Decision Support
  • Infinx CDSM
  • LogicNets’ Decision Engines
  • New Century Health’s CarePr
  • Reliant Medical Group CDSM

 

What information is provided to the ordering provider when they consult the AUC?

When the ordering provider consults the AUC, the system will indicate whether the clinical information provided for the exam adheres or does not adhere to the AUC.

 

What do modifiers communicate and does every advanced imaging procedure code require a modifier?

For Medicare patients, every outpatient advanced imaging procedure will require a modifier.

Modifiers communicate the following:

  • If the consultation adhered to the AUC recommendation,
  • If the consultation did not adhere to the AUC recommendation or;
  • No consultation was required due to an exception for location (e.g., inpatient), type of patient (e.g., emergent) or ordering provider (e.g., hardship).

 

Can a radiology practice/center perform this service for their referring physicians?

No. CMS allows the provider’s employed clinical staff to perform the consultation on behalf of the ordering provider. No other entity or individual, including the radiologist may perform the AUC consultation.

 

 

 

 

Diagnostic Imaging Northwest is working hard to put the pieces in place to make this new CMS requirement as easy as possible for our referring providers. We look forward to sharing those with you soon!


For more information on Medicare and Appropriate Use Criteria, please visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program/index.html

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